When You've Been Denied Coverage
If you find that your health insurance organization will not cover the type of hyperhidrosis treatment your healthcare provider recommends, enlist the help of your physician, physician assistant or nurse practitioner (or medical office staff) to question and appeal the organization’s decision. Remember, hyperhidrosis is a serious and relatively common medical condition that research has shown has significant negative impacts on quality of life, physical health and mental wellbeing (see the key facts here). With this in mind, ask your insurance company's decision-makers to reconsider.
- Ask someone from your healthcare provider's office to talk (or write) to the insurance company. This should be your first step. Most medical offices have standard letters of appeal for denied coverage and insurance companies always have a standard appeal process to follow. A healthcare professional with an understanding of your condition and situation can explain why a particular hyperhidrosis treatment is necessary, why excessive sweating is a health concern, and how it may affect other aspects of your health. Facilitate this process by printing our sample Letter of Medical Necessity, Hyperhidrosis Preauthorization Request Form, and (for iontophoresis) Medical Insurance Claim Statement Form for the purchase of a home-use iontophoresis device. Give these documents to the relevant person at your provider's office so he/she can then fill out and submit them.
- Call your insurance company. There’s usually a toll-free or "800" number you can use. You will most likely end up speaking with a customer service representative. Don’t be afraid to ask for his or her manager.
- Keep good records. Make a note of the dates and times you speak with customer service representatives. Write down their names and the information they give you. Keep any written correspondences regarding your hyperhidrosis treatment and reimbursement in a file.
- Become hyper-educated. Visit our Scientific Literature section to read and download studies that have been published in major academic and medical journals. This research informs policy decisions and influences the standard of care.
- Submit your requests in writing. Write a letter to your insurance company. Include copies of receipts for treatments not reimbursed, information about the Cost of Hyperhidrosis, medical test results, and statements from your physician (including a Letter of Medical Necessity, Hyperhidrosis Preauthorization Request Form, and, for iontophoresis, a Medical Insurance Claim Statement Form for the purchase of a home-use iontophoresis device). Include how hyperhidrosis has affected you physically and emotionally. Have you experienced depression or anxiety? Skin infections or irritation? Do you have difficulty gripping the steering wheel while driving, putting yourself or others at risk? Have you ever dropped objects, slipped, or otherwise experienced a safety issue due to your excessive sweating?
- Always include your full name, address, and insurance policy or health plan number on all letters, e-mails, or faxes.
- Appeal. If you’ve already submitted a request for coverage and have been denied, write another letter appealing the decision. Following an "appeals process" is useful if your request is denied, so ask what this process requires. Appeals can take time, but are a good way to get in contact with decision-makers.
- Talk to your human resources (HR) or benefits manager (if you have one). If you receive your health insurance coverage through your job, your HR manager may be able to help. Keep your HR department informed and give them copies of all correspondence with the insurance company.
- Conduct research. Do other insurance companies cover the desired treatment? (Visit our links to public hyperhidrosis coverage policies for this information) If so, mention them during your dealings with your own company.
- Follow up. Because it’s easy for letters and calls to get lost in piles of other paperwork, contact your insurance company often. Make sure your requests are being attended to and find out when you may expect a response. Try to get a specific point of contact within the insurance company, and his/her direct number so that you do not have to keep repeating your story to multiple individuals.
- If your request has been rejected, keep trying. At some insurance companies, a customer's third request gets forwarded to a person with more responsibility and decision-making power.
- Contact your state’s insurance commission. Many states have an insurance commission, an organization that oversees the sale and implementation of insurance, including health insurance. Your state insurance commission may be a resource for helping you with health insurance coverage problems.
- Write to elected state and federal officials. Explain your position and ask for their support. Try regular mail, emails and faxes.
- Let us know whether or not your health insurance organization covers your hyperhidrosis treatments. If you have had to go through an appeals process, tell us how it’s going. One of the International Hyperhidrosis Society’s goals is to improve access to hyperhidrosis treatments, including health insurance coverage for treatments. Any information you can provide about your experiences will help us as we work towards achieving this goal. E-mail your comments to Info@SweatHelp.org.
- If, after the appeal process, you are STILL denied coverage for your hyperhidrosis treatment (such as for a home-use iontophoresis device), consider whether self-pay makes sense and is possible for you. Add up all of the out-of-pocket expenses you have accrued since the start of your hyperhidrosis. These will include: dry cleaning/laundering bills, new clothes/shoes to replace those ruined, over-the-counter remedies, prescriptions, replacement smart phones or other tech tools damaged by wetness, counseling (if applicable), etc. After calculating these expenses (which do not include the TIME it takes you to manage your condition), you may find that the self-pay makes economical sense in the long-run.
- Finally, while not technically insurance-related, clinical trials are another potential avenue for patients seeking treatment for hyperhidrosis. Clinical trials help to further medical science's understanding of a condition and its therapy. To learn more about open research studies in hyperhidrosis, how they can make treatment more affordable (even free), and whether you may be eligible to participate in a hyperhidrosis trial, visit our research opportunities page to see who's enrolling now!